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B. E. Frueh, C. Tappeiner; Cross-Linking in Children With Progressive Keratoconus. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4972.
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To report on the results and safety of cross-linking (CXL) in children with progressive keratoconus
Evaluation of CXL procedures in children (< 18 years of age). Standardized CXL with an 8-mm epithelial abrasion, riboflavin and UV-A irradiation was performed. 12 children (14 eyes), all boys, with a mean age of 14.2 years (range 8-18), underwent uneventful CXL. Refraction and topography were documented pre-CXL and at 1,4, and 12 months postoperatively.
Postoperative complications included one central corneal infiltrate and peripheral sterile infiltrates. Mean follow-up was 6.6 months. Mean spherical equivalent was -5.2 D before CXL, -6.7 D at 1 month and -5.4 D at 4 months. Average keratometry was 48.4 D preoperatively, 47.5 D at 1 month and 48.7 D and 49.5 (n=5) D at 4 and 12 months. The mean topographic cylinder increased from a preoperative 4.5 D to 5.9 D at 1 month and then decreased to 4.4 D at 4 months. Topographic indices (SAI and SRI) remained stable. The thinnest point, measured by Pentacam was preoperatively 475.6 µm, at 1 month 416 µum and at 4 months 442.8 µm. Progression of keratoconus was stopped in every case. BSCVA improved in 4 cases (2 to 4 lines), decreased in 3 cases (3 and 4 lines) and was unchanged in 4 cases.
CXL in children appears to be a safe procedure. Progression of keratoconus, even in eyes exhibiting extremely rapid deterioration, was arrested in every case. A longer follow-up will be required to determine whether repeated CXL is needed in children.
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